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PubMed2006

Detection of the norovirus variants GGII.4 hunter and GGIIb/hilversum in Italian children with gastroenteritis.

Noroviruses (NoVs) are important enteric pathogens of humans. Although they exhibit an impressive genetic diversity, few NoV strains appear to predominate worldwide. Limited epidemiological data are available on NoV gastroenteritis in Italy. In this study, we assessed the prevalence of human NoV in Italian children with gastroenteritis by using a reverse-transcription nested polymerase chain reaction (RT-PCR) assay specific for the RNA-dependent RNA polymerase (RdRp) on faecal samples collected throughout the 2004 surveillance activity in Palermo, Italy. NoVs were detected in 47% of the stool samples obtained from children <5 years age, admitted to hospital with acute non-bacterial gastroenteritis. A selection of strains was further analyzed by partial sequence analysis of the RdRp gene. The strains were characterized as genogroup (GG) II and clustered into two distinct virus populations that resembled the emerging European GGIIb/Hilversum strains and the Australian Hunter GGII.4 strains. A temporal pattern of distribution of the two NoV strains was observed which was consistent with an independent circulation of two separate strains in the local population. Based on this 1-year study we concluded that NoVs were a diffuse cause of sporadic cases of acute childhood gastroenteritis and that strains of global epidemiological relevance were circulating in Palermo, Italy in 2004.

Caliciviridae Infections↗

PubMed2002

Experimental infection of Macaca nemestrina with a Toronto Norwalk-like virus of epidemic viral gastroenteritis.

Norwalk virus (NV) and Norwalk-like viruses (NLVs) are common etiologic agents of viral gastroenteritis. Viral gastroenteritis is a common disease that is highly transmissible, spreading rapidly through families, institutions, and communities. Because methods for in vitro cultivation of Norwalk etiologic agents are not available, information regarding this syndrome has come largely from studies in human volunteers. Sequential passaging of an NLV through an immunoincompetent newborn pigtail macaque (Macaca nemestrina) may allow for the adaptation of a human NLV to a primate host, thus providing an animal model for investigating this disease. A fecal filtrate of human origin containing NLV, Toronto virus P2-A, was obtained from a patient during an epidemic of viral gastroenteritis. The filtrate was administered via nasogastric tube to three newborn pigtailed macaques. Clinical illness, which was characterized by diarrhea, dehydration, and vomiting, occurred in three monkeys. Reverse transcription-polymerase chain reaction (RT-PCR) and oligonucleotide probe analysis of RNA extracted from the stool samples following infection revealed viral RNA in all inoculated monkeys. Infection was also transmitted experimentally by feeding two additional newborn macaques a fecal filtrate prepared from the three previously infected animals. Detection of viral RNA in the stools of animals that received the fecal filtrate indicates that viral replication occurred in association with clinical illness. The susceptibility of Macaca nemestrina to infection with a Norwalk-like agent will facilitate the study of the mechanisms of the pathogenesis of NLV. This system may also have the potential to serve as a vaccine test model for human epidemic viral gastroenteritis.

Animals↗

PubMed1996

Overview of viral gastroenteritis.

Diarrheal illnesses in humans have been recognized since antiquity. Such illnesses continue to take a great toll of lives, with a disproportionately high mortality in infants and young children in developing countries. Bacteriologic and parasitologic advances made during the past century led to the discovery of the etiology of some of the diarrheal illnesses, but the etiology of the major portion remained unknown. It was assumed that viruses caused most of these illnesses because: (i) bacteria were recovered from only a small proportion of episodes, and (ii) bacteria-free filtrates were found to induce gastroenteritis in adult volunteer studies. However, an etiologic agent could not be recovered despite the "golden age" of virology in the 1950's and 1960's when tissue culture technology enabled the discovery of numerous cultivatable enteric viruses, none of which emerged as an important etiologic agent of gastroenteritis. The discoveries of the Norwalk virus in 1972, and of rotaviruses in 1973, both without the benefit of in vitro tissue culture systems, ushered in a new era in the study of the etiology of viral gastroenteritis. The Norwalk virus was found to be an important cause of non-bacterial epidemic gastroenteritis in adults and older children, and rotaviruses were shown to be the single most important etiologic agents of severe diarrheal illnesses of infants and young children in both developed and developing countries. With the major advances in the study of rotaviruses, there is a high degree of optimism that in the not-too-distant future, a rotavirus vaccine will be available. In addition, the recent molecular biologic advances in the study of the Norwalk and Norwalk-like viruses, now firmly established as caliviviruses, represent a major new horizon in the study of these viruses.

Diarrhea↗

PubMedDate not supplied

Rotavirus gastroenteritis.

Rotavirus is the single most important cause of severe, dehydrating gastroenteritis in infants and young children worldwide. Rotavirus gastroenteritis is associated with high morbidity in developed countries and significant mortality in developing countries. Virtually all children are infected with rotavirus by 3 years of age. Fecal-oral transmission is the most likely route of virus spread. Group A serotype strains G1 through G4 account for more than 90% of rotavirus gastroenteritis in humans, with G1 being the predominant serotype. The virus preferentially infects the mature small-intestinal enterocytes. Rotavirus gastroenteritis is characterized by fever, vomiting, and diarrhea, with vomiting particularly prominent. Dehydration is a frequent complication because of the severity of the diarrhea and the associated vomiting. Rehydration and maintenance of proper fluid and electrolyte balance remain the mainstay of treatment. Hygienic measures have little effect on the reduction of rotavirus infection rates. The disease can be effectively controlled by universal rotavirus vaccination.

Child, Preschool↗

PubMed2005

Existence of multiple outbreaks of viral gastroenteritis among infants in a day care center in Japan.

A total of 921 fecal specimens collected from 44 infants in a day care center (DCC) in Tokyo, Japan during June 1999 to July 2000 were tested for the presence of rotavirus, norovirus, sapovirus, astrovirus and adenovirus by reverse-transcription-multiplex polymerase chain reaction (RT-multiplex PCR) and sequence analysis. Of 88 fecal specimens from infants with acute gastroenteritis, 51.1% (45) were found to be positive for diarrheal viruses. Astrovirus was the most prevalent (15.9%, 14 of 88), followed by norovirus GII (14.8%, 13 of 88), adenovirus (12.5%, 11 of 88), and sapovirus (2.3%, 2 of 88). Viral mixed infection accounted for 5.7% (5 of 88). Interestingly, 230 of 833 (27.6%) fecal specimens collected from asymptomatic infants were also infected with diarrheal viruses. Of these, astrovirus, norovirus GII, adenovirus and sapovirus were identified in 53, 46, 96 and 22 fecal specimens (23%, 20%, 41.7%, and 9.6%, respectively). Moreover, 13 of 833 (1.6%) normal specimens showed mixed viral infections. Surprisingly, no rotavirus (known as the most common causative agent of acute gastroenteritis in DCCs) was detected in those subjects. Another interesting feature was the demonstration of five separate outbreaks of acute gastroenteritis identified in a single DCC. Outbreak A was associated with both astrovirus serotype 1 and norovirus GII/3 (known as Toronto virus cluster); Outbreak B with adenovirus 12; Outbreak C with norovirus GII/4 (Lordsdale virus cluster); Outbreak D with sapovirus GIV and Outbreak E with astrovirus serotype 1. To our knowledge, this is the first proof of multiple outbreaks of viral gastroenteritis in Japanese infants in a single DCC. Our results confirm the presence as well as the importance of these viruses and warn of the threat they pose.

Adenovirus Infections, Human↗

PubMed2005

Diagnostic value of bacterial stool cultures and viral antigen tests based on clinical manifestations of acute gastroenteritis in pediatric patients.

The study presented here aimed to elucidate the diagnostic value of bacterial stool cultures and viral antigen tests when performed based on the clinical characteristics of acute gastroenteritis in infants and young children. A total of 21 (11.2%) bacterial and 74 (39.6%) viral infections affecting 187 children under the age of 3 years was investigated. Blood (p<0.001) and mucus (p=0.014) in the stool and a C-reactive protein (CRP) level of >or=50 mg/l (p=0.006) were more significantly associated with gastroenteritis of bacterial rather than viral origin. Vomiting (p<0.001) was significantly associated with viral gastroenteritis. Among children with bloody stool, culture grew a Salmonella spp. in 35% and for vomiting children, stool antigen tests detected rotavirus in 60% of cases. In conclusion, etiologic tests to determine the cause of childhood gastroenteritis according to their characteristic clinical features or laboratory test results, or both, are of low diagnostic value.

Acute Disease↗

PubMed2001

Effect of gastroenteritis during pregnancy on neonatal outcome.

Previous studies have shown that gastrointestinal disease in women during pregnancy may be a risk factor for low-birthweight infants. In the present study, the prevalence of gastroenteritis during pregnancy and its effect on neonatal outcome was examined for each gestational month in 10,597 single-birth mother-infant pairs in the ABIS Project (All Babies in Southeast Sweden). After exclusion of mothers with inflammatory bowel disease, celiac disease, lactose intolerance, or cow's milk allergy, data on the remaining 10,229 mother-infant pairs were compiled. Overall, 32.5% of the mothers suffered from gastroenteritis during pregnancy (95% confidence interval [CI], 32.5-32.5%). Risk factors included young maternal age (P for trend, <0.001), previous infants (P<0.001), work in a pediatric day-care facility (P=0.004), and experience of a major life event (P=0.027). Binary logistic and multiple linear regression analyses were adopted for the following variables of neonatal outcome: birth week, preterm birth (<37 weeks), birthweight, low birthweight (< or = 2,499 g), birth length, cesarean section, and hospitalization in a neonatal care unit. Maternal gastroenteritis during month 4 (-0.18 week; 95%CI=-0.36, -0.01 week), month 5 (-0.30 week; 95%CI=-0.49, -0.11 week), or month 7 (-0. 18 week; 95%CI=-0.35, -0.01 week) of pregnancy was associated with a shorter pregnancy (adjusted for confounders). Gastroenteritis during part of the pregnancy was associated with a shortened pregnancy, but it had no other adverse effects on neonatal outcome. The reduction in the duration of pregnancy is probably of little clinical relevance. These findings should be confirmed in a prospective study.

Adolescent↗

PubMed1979

Epidemic viral gastroenteritis.

Epidemic viral gastroenteritis is a significant world wide problem. In developed countries, gastroenteritis accounts for significant morbidity and loss of time from work; in the Third World it is the leading cause of mortality among infants and children. Recent technologic advances have been associated with an explosion of research activity. Two virus groups, the Norwalk-like agents and the rotaviruses, are currently accepted as causative agents of viral gastroenteritis in man. The problem of viral gastroenteritis is reviewed both from a current and a historic perspective.

Adult↗

PubMed1992

Deposition of eosinophil granule major basic protein in eosinophilic gastroenteritis and celiac disease.

Degrees of eosinophil infiltration and eosinophil degranulation, as evidenced by localization of the eosinophil granule major basic protein (MBP), were compared in patients with eosinophilic gastroenteritis, patients with celiac disease, and healthy controls using a specific indirect immunofluorescence technique for the localization of MBP. Formalin-fixed, paraffin-embedded biopsy specimens from the mucosa of the stomach and small intestine of 11 patients with eosinophilic gastroenteritis, from the small intestine of 4 patients with celiac disease, and from the stomach and/or upper small intestine of 18 healthy asymptomatic volunteers were tested. Degrees of eosinophil infiltration and extracellular deposition of MBP were graded by two blinded observers; each section was given a score from 0 (nil) to 4 (marked). In the small bowel biopsy specimens, both eosinophil infiltration and extracellular MBP deposition scores were significantly greater in patients with eosinophilic gastroenteritis and in patients with celiac disease than in controls. In the gastric biopsy specimens, extracellular MBP deposition scores were significantly increased in patients with eosinophilic gastroenteritis compared with controls even though eosinophil infiltration scores did not differ significantly at this site. The results support the hypothesis that the eosinophil, through toxic cationic proteins such as MBP, plays a role in the pathogenesis of these diseases.

Adolescent↗

PubMedDate not supplied

Benign convulsions with mild gastroenteritis: a report of 10 recent cases detailing clinical varieties.

To better define the characteristic clinical features of benign convulsions with mild gastroenteritis, recently recognized as a new entity in Japan, we reviewed all the 10 patients we have seen from 1992 to 1994. The clinical features have been previously reported in the literature to be afebrile generalized tonic-clonic seizures occurring between the first and the fifth sick day of mild gastroenteritis. In our series, four of 10 patients had convulsions before the onset of gastroenteritis. Overall, seizures were mostly brief and often repetitive occurring in cluster (19 seizures/10 episodes). Among these, a prolonged or partial seizure was frequently observed. In six of the 10 patients, the seizure type changed during an episode: from generalized to partial seizures (n = 2), from partial to generalized seizures (n = 2), or from partial to another type of partial seizures (n = 2). None in our series experienced a recurrence episode of afebrile convulsion during follow-up. These findings suggest that benign convulsions with mild gastroenteritis exhibit some variations in their clinical manifestation.

Child, Preschool↗

PubMed2006

Prevalence and antimicrobial susceptibility patterns among gastroenteritis-causing pathogens recovered in Europe and Latin America and Salmonella isolates recovered from bloodstream infections in North America and Latin America: report from the SENTRY Antimicrobial Surveillance Program (2003).

Gastroenteritis-causing pathogens are the second leading cause of morbidity and mortality worldwide. Complicating the clinical diarrhoea syndrome is the emergence of antimicrobial resistance among the responsible bacterial pathogens. The reported increases in fluoroquinolone resistance in Salmonella, Shigella and Campylobacter have been extremely worrisome considering the primary role of ciprofloxacin as a treatment. In this study, 1479 bacterial isolates from gastroenteritis infections were collected in Europe and Latin America, which included Salmonella spp. (834; 56%), Shigella spp. (311; 21%), Campylobacter spp. (182; 12%) and Aeromonas spp. (72; 5%). The fluoroquinolones displayed the greatest activity against these pathogens, with only three non-Campylobacter spp. strains being non-susceptible using current Clinical and Laboratory Standards Institute (CLSI) breakpoint criteria. Whilst ciprofloxacin resistance in European and Latin American Salmonella was only 0.2% and 0.0%, respectively, a total of 16.2% and 12.9% of isolates were resistant to nalidixic acid, indicating possible first-step gyrA mutations. Among confirmed extended-spectrum beta-lactamase-producing Salmonella strains, CTX-M genes were detected in 15 originating from Russia. Erythromycin and azithromycin were the most potent agents tested against Campylobacter spp. (values of minimum inhibitory concentration for 90% of the organisms, 0.5 mg/L and 0.12 mg/L, respectively), with erythromycin displaying the highest susceptibility (91.1%). Salmonella isolates from bloodstream infections displayed antibiograms that were nearly identical to strains causing gastroenteritis. Considering the role that antimicrobial therapy plays in the management of moderate to severe bacterial gastroenteritis, global surveillance and local/national public health programmes can provide critical data illuminating the dissemination of resistance and guidance for empirical therapy.

Aeromonas↗

PubMed2004

Long-term features of norovirus gastroenteritis in the elderly.

Noroviruses are important pathogens in both sporadic cases and outbreaks of gastroenteritis in humans. Noroviruses can affect individuals of all ages in a variety of settings, but are a particularly important cause of gastroenteritis in aged-care facilities. The relationship between clinical symptoms and norovirus excretion and the possible role of asymptomatic carriage of norovirus in the elderly are poorly understood. This study examined symptoms and norovirus excretion in elderly individuals associated with a norovirus outbreak in an aged-care facility. Ten individuals aged 79-94 years were recruited for the study. Nine were symptomatic and one was an asymptomatic contact who subsequently developed gastroenteritis. The 10 participants were interviewed regarding their clinical symptoms between two and six times over a three-week study period. One or more sequential faecal samples were collected from all participants over the same period and tested by reverse transcription-polymerase chain reaction for the presence of norovirus. Norovirus was detected in faecal samples from all 10 study participants and was commonly detected in formed stools. In the nine symptomatic participants, acute symptoms such as diarrhoea and vomiting had largely resolved by the third or fourth day of illness, but non-specific symptoms such as headache, thirst and vertigo could persist for as long as 19 days. Both acute and non-specific symptoms appeared to resolve and recur in some participants. The median excretion time for norovirus was 8.6 days (range 2-15 days) in symptomatic participants (N=5). There was no general relationship between the duration of norovirus excretion and the duration of either acute or non-specific symptoms. A faecal sample collected from the asymptomatic contact the day before gastroenteritis symptoms began was positive for norovirus, demonstrating prodromal excretion of norovirus. The results of this study indicate that infection control guidelines should consider both long-term excretion and prodromal excretion of norovirus, and the possibility that formed stools can contain norovirus. Furthermore, the care of elderly individuals recovering from a norovirus infection should take long-term non-specific clinical symptoms into account.

Aged↗

PubMed2005

Institutional risk factors for outbreaks of nosocomial gastroenteritis: survival analysis of a cohort of hospital units in South-west England, 2002-2003.

Nosocomial outbreaks of gastroenteritis are a major burden on hospital inpatient services, costing an estimated pound115 million annually to the English National Health Service. We actively followed-up 171 inpatient units from four major acute hospitals and 11 community hospitals in South-west England for one year. Outbreaks of gastroenteritis were ascertained through an active surveillance network using standard clinical definitions. Survival analysis Cox regression models using an outbreak of gastroenteritis as the endpoint were fitted to identify institutional and operational attributes related to increased outbreak rates at the level of the care unit. Greater number of beds in unit [hazard ratio (HR) 1.22 (per 10 additional beds), 95% confidence intervals (CI) 0.96-1.55] was associated with increased hazard, as were geriatric (HR 2.6, 95%CI 1.6-4.3) and general medical (HR 1.7, 95%CI 1.1-2.6) care units. The average length of stay on a unit was inversely associated with outbreak incidence [HR=0.89 (per additional week of stay), 95%CI 0.80-0.99]. Larger care units and those with higher throughput have increased rates of gastroenteritis outbreaks. These results should guide infection control policy and support the design of hospitals with smaller care units.

Caliciviridae Infections↗

PubMed1982

Gastroenteritis associated with enteric type adenovirus in hospitalized infants.

Enteric types of adenovirus have recently been identified as a causative agent of infantile gastroenteritis. We utilized enzyme immunoassay and tissue culture techniques to evaluate prospectively the role of ET Ad in diarrhea occurring in hospitalized infants. We found that ET Ad was associated with 14 of 27 cases of diarrhea occurring during a 12-week study period in the late autumn and early winter months; ET Ad was found in the stool of only one of 72 children without diarrhea (P less than 0.001). Although adenoviruses other than ET Ad were found in the stools of two of the 27 children with diarrhea, such viruses were also found in the stools of five of 72 children without diarrhea and thus could not be statistically correlated with acute gastroenteritis. Children infected with ET Ad had diarrhea for a mean of 8.0 days, compared to a mean duration of 4.2 days for the children with gastroenteritis not associated with ET Ad. Thirteen of the 14 children with ET Ad gastroenteritis had respiratory symptoms such as cough, rhinorrhea, or wheezing, six had roentgenographic evidence of pneumonia, and three children had bilateral conjunctivitis. This study documents that ET Ad can be an important cause of acute gastrointestinal disease in hospitalized infants and young children and that gastrointestinal infections with ET Ad can be associated with a high rate of respiratory disease.

Adenoviridae Infections↗

PubMed2006

[Norovirus gastroenteritis outbreak by person-to-person transmission in a nursing home].

BACKGROUND AND OBJECTIVE: The aim of this study was to conduct an investigation into an outbreak of gastroenteritis among health workers and residents (with different grades of dependence) at a nursing home. PATIENTS AND METHOD: We detected an outbreak of gastroenteritis in a group of 52 health workers and 124 residents at a nursing home in Oliana, Lleida (Spain). A bidirectional prospective and retrospective cohort study was conducted into the consumption of water, food, grade of dependence (high, medium and low), and specific job. We studied the water supply and six food items. Faecal specimens from 30 patients were cultured and examined for Norovirus by polymerase chain reaction-reverse transcription. The possible implication of different factors associated with gastroenteritis was assessed by relative risk (RR) at 95% confidence intervals (CI). RESULTS: We interviewed 97% of the patients (172/176). The overall attack rate was 53.3% (92/172). The symptoms were: diarrhoea 68.5% (63/92), vomiting 64.1% (59/92), nausea 63.0% (58/92), fever 33.7% (31/92), abdominal pain 28.3% (26/92), and headache 14.1% (13/92). The epidemic curve highlighted transmission for 19 days. The risk factors associated with gastroenteritis were high (RR = 1.6; 95% CI, 1.0-2.6) and medium (RR = 2.8; 95% CI, 1.0-8.0) levels of dependence, health worker with high level of contact with residents (RR = 2.8; 95% CI, 1.1-7.3) and those doing cleaning work (RR = 2.8; 95% CI, 1.0-8.0). Bacterial cultures were negative for samples of food and water. Also, cultures were negative for bacteria in faecal samples but tests were positive for Norovirus in 12 faecal samples. CONCLUSIONS: We showed a Norovirus outbreak in a nursing home, person-to-person spread, associated to high and medium grades of dependence among residents, health worker with high level of contact with them and with those doing cleaning work.

Adult↗

PubMed2004

Increase in viral gastroenteritis outbreaks in Europe and epidemic spread of new norovirus variant.

BACKGROUND: Highly publicised outbreaks of norovirus gastroenteritis in hospitals in the UK and Ireland and cruise ships in the USA sparked speculation about whether this reported activity was unusual. METHODS: We analysed data collected through a collaborative research and surveillance network of viral gastroenteritis in ten European countries (England and Wales were analysed as one region). We compiled data on total number of outbreaks by month, and compared genetic sequences from the isolated viruses. Data were compared with historic data from a systematic retrospective review of surveillance systems and with a central database of viral sequences. FINDINGS: Three regions (England and Wales, Germany, and the Netherlands) had sustained epidemiological and viral characterisation data from 1995 to 2002. In all three, we noted a striking increase in norovirus outbreaks in 2002 that coincided with the detection and emergence of a new predominant norovirus variant of genogroup II4, which had a consistent mutation in the polymerase gene. Eight of nine regions had an annual peak in 2002 and the new genogroup II4 variant was detected in nine countries. Also, the detection of the new variant preceded an atypical spring and summer peak of outbreaks in three countries. INTERPRETATION: Our data from ten European countries show a striking increase and unusual seasonal pattern of norovirus gastroenteritis in 2002 that occurred concurrently with the emergence of a novel genetic variant. In addition to showing the added value of an international network for viral gastroenteritis outbreaks, these observations raise questions about the biological properties of the variant and the mechanisms for its rapid dissemination.

Caliciviridae Infections↗

PubMed1989

Viral gastroenteritis aboard a cruise ship.

A 32-nm small round structured virus (SRSV), possibly related to the Snow Mountain agent (SMA), was implicated as the cause of recurrent outbreaks of gastroenteritis on a cruise ship. There was no identifiable relation to food or water consumption, but the risk of gastroenteritis among passengers who had shared toilet facilities was twice that of those who had a private bathroom and the rate of illness was related to the number of passengers sharing a communal restroom (ie, with one or more toilets): contaminated bathrooms may be an important vehicle for person-to-person spread of this enteric agent. In each cabin, index patients who had vomited in their cabins were more likely to have had cabinmates who subsequently became ill than were index patients who had not vomited. These epidemiological findings implicate vomitus in the transmission of viral gastroenteritis and they are consistent with the transmission of viral agents by airborne droplets or person-to-person contact. New strategies for prevention of viral gastroenteritis should include protection against environmental contamination by viruses in airborne droplets or vomitus.

Acute Disease↗

PubMed1994

Predicting likelihood of gastroenteritis from sea bathing: results from randomised exposure.

The health effects of bathing in coastal waters is an area of scientific controversy. We conducted the first ever randomised "trial" of an environmental exposure to measure the health effects of this activity. The trial was spread over four summers in four UK resorts and 1216 adults took part. Detailed interviews were used to collect data on potential confounding factors and intensive water quality monitoring was used to provide more precise indices of exposure. 548 people were randomised to bathing, and the exposure included total immersion of the head. Crude rates of gastroenteritis were significantly higher in the exposed group (14.8 per 100) than the unexposed group (9.7 per 100; p = 0.01). Linear trend and multiple logistic regression techniques were used to establish relations between gastroenteritis and microbiological water quality. Of a range of microbiological indicators assayed only faecal streptococci concentration, measured at chest depth, showed a significant dose-response relation with gastroenteritis. Adverse health effects were identified when faecal streptococci concentrations exceeded 32 per 100 mL. This relation was independent of non-water-related predictors of gastroenteritis. We do not suggest that faecal streptococci caused the excess of gastrointestinal symptoms in sea bathers but these microorganisms do seem to be a better indicator of water quality than the traditional coliform counts. Bathing water standards should be revised with these findings in mind.

Adult↗